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

Sometimes the injury is a broken nose - a flow of blood, a few minutes of treatment on the sideline, and perhaps a protective mask and a quick return to play - which can turn into a permanent injury that leaves the player suffering 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 dangers in football.

Ardesh, who has treated professional athletes including football players, said: 'Sometimes a minor injury from the outside can cause severe damage inside.'

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

With many players participating in the 2026 World Cup wearing protective face masks after sustaining jaw or facial injuries, the hidden injuries in football have become increasingly visible.

Englishman Jed Spence, Austrian Stefan Posch, and Algerian goalkeeper Luka Zidane all played with protective face masks. Other notable recent cases include Frenchman Kylian Mbappé wearing a mask to protect his broken nose at Euro 2024, and Croatian Joško Gvardiol's protective mask at the 2022 World Cup.

To viewers, the mask may seem like a sign of toughness. But for surgeons like Ardesh, it is often an indicator of the effects of trauma.

Ardesh said: 'The face is very fragile after an injury, whether 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 top speed and jumping very high. And when you talk about an elbow or shoulder hitting the nose directly, it's somewhat like receiving a strong punch to the face.'

He pointed out that the ball itself is rarely the main cause; rather, 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 faces. It's the first thing likely to receive any kind of impact.'

A broken nose can lead to chronic obstruction, a deviated septum, long-term breathing problems, or a visibly crooked nose or the need for reconstructive surgery months later if not properly assessed. 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 in the best possible way.'

In the moments after a strong blow, the first steps are to control bleeding and rule out a more serious injury, and to lean forward to prevent blood from 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 emphasized that if the injury seems more than a bruise, it will require imaging scans to check for fractures of the eye socket, cheekbone, or jaw, as well as a 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 after three to six months 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 individual case.'

Algerian goalkeeper Luka Zidane played a World Cup match with a mask (Reuters)

Goalkeepers are particularly at risk because they constantly collide with players while trying to save the ball.

Ardesh said: 'They can get hit by elbows, heads, or knees. They are at higher risk of direct impact to the face.'

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

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