When soccer players collide in midair, the toll is not always counted in concussions, torn ligaments or twisted ankles.

It is a risk that Dr. Farhad Ardesh, a Beverly Hills facial plastic and reconstructive surgeon, says remains one of soccer's most underestimated.

"Sometimes a minor injury on the outside can cause major damage on the inside," said Ardesh, who has treated professional athletes, including soccer players.

"You might have the nose that just looks a little swollen or a little crooked, but the inside of the nose actually has a zigzag pattern or an ​S-shaped deformity that's really affecting this player's breathing."

With several players at the 2026 World Cup competing in protective facial masks after jaw or facial injuries, soccer's hidden trauma has become ​increasingly visible.

England's Djed Spence, Austria's Stefan Posch and Algeria goalkeeper Luca Zidane have all played with facial protection. Other recent high-profile cases include ⁠France's Kylian Mbappe 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 appear to ​be a badge of toughness. To surgeons such as Ardesh, it is often a sign of the effects of trauma.

Ardesh said the facial injuries suffered while playing the beautiful game can resemble those seen in boxing or mixed martial arts.

"People don't think of soccer as being a combat sport," he said. "But you've got elite athletes that are running as fast as humanly possible and jumping really high. When you're talking about ​an elbow or a shoulder directly to the nose, it's more or less like taking a right hook to the face."

The ball itself is rarely the main cause, he said. More ​often, injuries come from heads, shoulders, elbows, knees, feet or falls.

-Reuters