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

Sometimes the injury is a broken nose - a gush of blood, a few minutes of treatment on the sideline, and perhaps a protective mask and a quick return to play - only to become a permanent injury that leaves the player with difficulty breathing long after the match ends.

Dr. Farhad Ardesh, a facial plastic and reconstructive 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 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 suffering jaw or facial injuries, hidden injuries in football are becoming increasingly apparent.

Englishman Jed Spence, Austrian Stefan Posch, and Algerian goalkeeper Luka Zidane have 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 like a sign of toughness. But to surgeons like Ardesh, it is often an indicator of the effects of trauma.

Ardesh said: 'The face is very fragile after an injury, whether caused by trauma such as an elbow strike or by 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 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; 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 most prominent part of our face. It's the first thing likely to take any kind of impact.'

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

He added: 'If patients don't have 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 well as possible.'

In the moments after a heavy 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 nasal septal hematoma - 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 can make it difficult to assess fractures in the first hours after injury, and Ardesh emphasized that if the injury appears to be more than a bruise, imaging tests will be 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 swelling to subside before repositioning the bones. More delicate 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.'

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

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

Ardesh said: 'They may get hit by an elbow, head, or knee. 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 affirmed 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.'