As the World Cup spotlights athletic injuries, the president of the AAFPRS explains why plastic surgeons must look past the simple fracture to address long-term functional and aesthetic concerns.
By Jessie Gainor
With the 2026 World Cup currently commanding global attention, the intense, high-energy nature of elite soccer is on full display. Alongside the impressive athleticism comes the inevitable reality of high-impact collisions that frequently lead to facial trauma. For plastic surgeons, the tournament serves as a high-profile reminder of a common clinical challenge: the sports-related nasal fracture. While athletes, parents, and even some medical professionals often view a broken nose as a straightforward injury, facial plastic surgeons understand that the reality is far more intricate.
According to Anthony Brissett, MD, FACS, president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), nasal trauma involves a complex combination of injuries affecting both form and function. Because the nose serves as the central aesthetic feature of the face while also functioning as the primary airway, even seemingly minor injuries sustained on the field can have significant long-term consequences.
Evaluating the Acute Injury and Hidden Damage
In the immediate aftermath of a sports injury, controlling bleeding is the obvious priority. Direct pressure can often stop epistaxis, but early evaluation by a specialist is critical to rule out complications that go beyond a simple bone fracture. One of the most pressing concerns during this initial assessment is identifying a septal hematoma.
“A septal hematoma occurs when blood collects between the cartilage and its surrounding blood supply,” Brissett explains. “This represents a true surgical urgency because if left untreated, the cartilage can lose its blood supply and undergo necrosis. The result can be permanent loss of structural support and the development of a saddle nose deformity, characterized by collapse of the nasal bridge along with both cosmetic and functional breathing problems.”
In a busy plastic surgery practice, any patient presenting with significant trauma, bleeding, a visible change in appearance, or a change in breathing should be presumed to have a complex nasal injury until proven otherwise, adds Brissett. The septum, which serves as the central support structure, may be fractured or significantly displaced. Furthermore, injuries to the internal and external nasal valves can occur, ultimately having a greater impact on breathing than the fracture itself.
A significant challenge in early evaluation is that acute swelling can mask the true extent of the damage. Patients are typically reassessed after several days once the edema has subsided. “What may initially appear to be a straightforward fracture can later reveal significant septal deviation, cartilage injury, asymmetry, or disruption of critical support structures,” notes Brissett. The goal of the initial evaluation is to assess the entire nasal framework and identify injuries that could affect long-term structural support.
The Challenge of Delayed Presentation
It is incredibly common for patients to present to a plastic surgeon months or even years after a nasal injury that was never fully treated. Many patients mistakenly assume that once the post-injury swelling resolves, the tissue has healed appropriately.
A key concept that patients often fail to realize is that the acute treatment of a nasal fracture frequently focuses solely on repositioning the nasal bones. While this restores the alignment of the bony framework, it does not always address associated injuries involving the septum, cartilage, or nasal valves. As a result, patients may require additional treatment months later to fully restore nasal function and appearance.
Once healing has occurred in an uncorrected state, the clinical situation becomes substantially more complex for the surgeon. “Bones heal in their displaced position, scar tissue develops, and callus formation can create visible irregularities or palpable bumps along the nasal bridge,” says Brissett. Patients frequently present with persistent nasal obstruction, a crooked nose, asymmetry, dorsal irregularities, or collapse of structural support mechanisms.
At this delayed stage, treatment shifts from simple fracture reduction to reconstructive septorhinoplasty. These secondary procedures are commonly performed six months to a year after the initial injury, once healing has stabilized. The surgery may involve correction of septal deformities, reconstruction of the nasal valves, cartilage grafting, and the meticulous refinement of residual bony irregularities.
Prioritizing Both Form and Function
When evaluating a patient after nasal trauma, surgeons must encourage patients to think equally about function and form, says Brissett. Persistent concerns in either category indicate a more significant injury than a simple nasal bone fracture.
From a functional standpoint, ongoing difficulty breathing through the nose after initial swelling has resolved is a major red flag. Persistent nasal obstruction suggests underlying septal fractures, nasal valve collapse, or structural instability. Patients may also report chronic congestion, mouth breathing, worsening snoring, reduced exercise tolerance, or sleep disturbances. Aesthetically, patients should be evaluated further if they develop a visibly crooked nose, persistent asymmetry, saddle nose deformity, or contour irregularities.
The mechanism of injury plays a vital role in the diagnosis. High-energy injuries associated with contact sports like soccer, basketball, and hockey often cause more extensive damage than is initially appreciated, involving both the bony and cartilaginous framework.
“Ultimately, the best outcomes address both form and function,” says Brissett. “A nose that appears straight but does not breathe well is not an ideal result, just as a nose that breathes well but remains visibly deformed may not fully meet a patient’s goals.”
Wearable Technology and Modern Patient Expectations
As rhinoplasty continues to be one of the most requested facial plastic surgery procedures in the United States, a large percentage of consultations involve prior nasal trauma. Today’s patients—especially athletes—are far more informed than in previous generations and increasingly understand that rhinoplasty is not solely a cosmetic endeavor, according to Brissett.
There is a growing recognition that nasal function extends well beyond simply breathing better. The nose plays a critical role in airflow efficiency, sleep quality, physical performance, and overall wellness. Following the correction of significant nasal obstruction, patients frequently report improvements in exercise capacity, reduced fatigue, improved concentration, and better sleep quality.
Interestingly, the rise of wearable technology is changing how patients interact with their surgical outcomes. Devices such as the Apple Watch, Oura Ring, and Fitbit allow individuals to monitor sleep metrics, recovery scores, and heart rate variability.
“While these devices do not directly measure nasal airflow, many patients observe measurable improvements in sleep quality, recovery, and overall performance after restoration of normal nasal breathing,” says Brissett. For plastic surgeons, understanding how optimizing nasal function contributes to broader measures of health and performance is becoming an increasingly important aspect of patient care.
The Role of the Specialist
Whether treating an elite athlete injured on the World Cup stage or a weekend warrior playing in a local league, the most important message for physicians, patients, and parents is that there is no such thing as a simple broken nose.
Surgeons must maintain a “high index of suspicion” following nasal trauma, according to Brissett. Substantial facial trauma, epistaxis, visible changes in nasal appearance, and noticeable changes in airflow should all prompt comprehensive evaluation. While imaging studies like CT scans can be helpful in complex cases involving orbital or head trauma, the most important diagnostic tool remains a careful history and physical examination performed by a specialist with expertise in nasal anatomy.
“Ultimately, our goal is not simply to determine whether a nose is broken,” says Brissett. “Our goal is to preserve breathing, maintain facial harmony, optimize recovery, and help patients avoid long-term problems that can affect them for years to come.” PSP
Jessie Gainor is a contributing writer for Plastic Surgery Practice.
Photo: ID 94803811 © MaksimPasko | Dreamstime.com
