When football players collide in the air, the losses are not always limited to concussions, ligament tears, or ankle sprains.

Sometimes the injury is a broken nose - blood flow, a few minutes of treatment on the sideline, and perhaps a protective mask and a quick return to play - turning into a permanent injury that leaves the player struggling to breathe 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 injury from the outside can cause serious damage inside.'

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

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

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

To viewers, the mask may seem 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 injury, whether from trauma like an elbow strike or due to surgery. We want to protect the bones.'

Ardesh said facial injuries that occur 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 hitting the nose directly, it's somewhat like receiving a strong punch to the face.'

He noted 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 position and structure.

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

A broken nose can lead to chronic obstruction, deviated septum, long-term breathing problems, obvious nasal deviation, or 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, which is bleeding inside the wall that divides the nose, is one of the urgent concerns.

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

Swelling may make it difficult to assess fractures in the first hours after injury, and Ardesh stressed that if the injury seems more than a bruise, X-rays are needed 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 resetting 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 pitch. But we need to assess all injuries and create a customized plan for each case.'

Algeria goalkeeper Luka Zidan played a World Cup match with a mask (Reuters)

Goalkeepers are particularly vulnerable 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 facial impact.'

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

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