When football players collide in the air, the losses are not always limited to concussions, torn ligaments, or sprained ankles.

Sometimes an injury such as a broken nose—blood flow, a few minutes of treatment on the touchline, maybe a protective mask and a quick return to play—turns into a permanent injury that makes the player suffer from breathing difficulties long after the match ends.

Dr. Farhad Ardesh, a plastic and reconstructive facial surgeon in Beverly Hills, says this risk remains one of the most underappreciated in football.

Ardesh, who has treated professional athletes including football players, said: 'Sometimes a minor external injury can cause serious internal damage.'

He added: 'The nose may look slightly swollen or a bit crooked, but the inside actually has a zigzag pattern or S-shaped deformity that really affects the player's breathing.'

With many players participating in the 2026 World Cup wearing protective face masks after suffering jaw or facial injuries, hidden injuries in football are becoming increasingly apparent.

England's Jed Spence, Austria's Stefan Posch, and Algeria's goalkeeper Lucas Zidane all played with protective face masks. Other notable cases recently include France's Kylian Mbappé wearing a mask to protect his broken nose at Euro 2024, and Croatia's Josko Gvardiol's protective mask at the 2022 World Cup.

To viewers, the mask may seem like a sign of toughness. But to surgeons like Ardesh, it often indicates the aftermath of trauma.

Ardesh said: 'The face is very fragile after an injury, whether it's from trauma like an elbow strike or from surgery. We want to protect the bones.'

Ardesh said that facial injuries occurring during football can resemble those in boxing or mixed martial arts.

He added: 'People don't think of football as a combat sport. But you watch professional athletes running at full speed and jumping very high. When you talk about an elbow or shoulder directly hitting the nose, it's somewhat like taking a hard punch to the face.'

He noted that the ball itself is rarely the primary cause; injuries often come from heads, shoulders, elbows, knees, feet, or falls.

The nose is particularly vulnerable due to its location and structure.

Ardesh said: 'The nose is the protruding part of our face. It is the first thing likely to receive any kind of impact.'

A broken nose can lead to chronic congestion, a deviated septum, long-term breathing problems, or a visible nasal twist or the need for reconstructive surgery months later if not properly evaluated. For elite athletes, Ardesh said airflow can affect performance.

He added: 'If patients don't get good airflow through their noses, they won't perform at their best.'

He continued: 'The goal of rhinoplasty and septoplasty is not only to improve the aesthetic appearance of the nose but also to ensure they breathe as best as possible.'

In the moments after a hard impact, the first steps are to control bleeding and rule out a more serious injury, and to lean forward to prevent blood flowing down the throat.

Once the athlete reaches a specialist, a septal hematoma—bleeding inside the wall that divides the nose—is one of the immediate concerns.

If left untreated, it can cut off blood flow to the cartilage and cause a saddle-nose deformity.

Swelling can make it difficult to assess fractures in the first hours after injury, and Ardesh stressed that if the injury appears more than a bruise, imaging scans will be required to check for fractures of the eye socket, cheekbone, or jaw, as well as concussion.

In the case of an isolated nasal fracture, the doctor may wait one to two weeks for the swelling to subside before realigning the bones. More precise surgery, including rhinoplasty or septoplasty, may be performed three to six months later depending on breathing, appearance, and function.

He said: 'The goal for these players is to return to the field. But we need to assess all injuries and create a customized plan for each case.'

Algeria's goalkeeper Lucas Zidane played a match at the World Cup with a mask (Reuters)

Goalkeepers are especially vulnerable because they are constantly colliding with players when trying to save the ball.

Ardesh said: 'They can get hit by an elbow, head, or knee. They are at higher risk of direct facial impact.'

However, he does not expect mandatory facial protection to be widely accepted in a sport that relies on speed, wide vision, and comfort. He emphasized that players recovering from injury wearing protective masks is the most logical option.

He continued about professional players: 'These are fighters. They don't want to leave the field.'