Originally from Germany, Prescher came to the United States when he was ten years old. Prior to his fellowship, he got his Bachelor’s of Science at the University of California – Berkeley, attended the University of Arizona for medical school, and headed to the University of Chicago for plastic surgery residency.

Why Michigan?

“I’m interested in taking care of kids and adults, and the University of Michigan has a really nice mix of both of those things. It’s a very comprehensive training program,” said Prescher. Other craniofacial fellowship programs were also good, but many tend to have a pediatrics-only focus.

This opportunity to explore a whole breadth of subspecialties for patients of all ages, along with the clinical volume at Michigan Medicine, made him want to continue his practice here.

After a year-long fellowship in the department, he knows the craniofacial surgery team well, and it’s comforting to know he’s part of a team with dedicated mentors and a good support system.

Providing cleft care

That support system doesn’t just include his fellow surgeons. “The whole multidisciplinary cleft team is really well-established and works really well. Having that was very important to me,” Prescher said.

Kids with cleft palates tend to have associated issues, so the team gathers folks from different specialties, like audiologists, geneticists, social workers, and others, to help with treatment.

Prescher also has a unique understanding of what his cleft patients experience. He was born with a bilateral cleft, so he’s been through many of the same surgeries they get, which has informed how he works with these kids and their families.

It starts with making them feel like part of the team and that their opinion is valuable. “It’s easy to tell the parents or kids what surgeries they need at the time, but to have them understand why and how it can affect how they look and how it’ll affect the functional part of their anatomy is really important,” said Prescher.

The surgeons he looked up to did that, and they also treated him with good humor, which made appointments something to look forward to. It’s important to remember these patients aren’t coming to the hospital every day, and they may come in stressed or with other complex emotions.

His job is to make them feel as comfortable as possible and lay out a map of what to expect with their treatment. Those conversations can look different depending on their comfort level, but he takes cues from them and tailors his conversations to match what they need from him.

Looking at past and future research

Prescher has a lot of research interests. One subject he explored in his past research was the impact of distraction osteogenesis. For some kids, it’s difficult to move their bone all at once, so they distract the bone and soft tissue slowly to make a bigger bone.

“Timing’s really critical in some of these surgeries. You’re trying to figure out when to intervene while the kid is still growing and how the bone’s movement is going to affect the soft tissues,” said Prescher. They want to maximize what they can get out of these kids’ natural growth, but striking that balance with multiple factors at play can be challenging.

He’s also looked at factors that lead patients with traumatic hand and facial injuries to miss post-surgery followup appointments. In places like Michigan, he notes, there are a lot of socioeconomic factors that can affect their care.

This ties into what he’d like to explore next: outcomes. In the spirit of trying to do better for our patients, he’s interested in looking at outcome data over the past 10 or 20 years to identify areas where care could be improved.

First year as faculty

With his first clinic as faculty all booked up, Prescher’s looking at a lot of variety in the cases he’ll be taking on. He’ll be providing the full breadth of cleft care – especially jaw surgeries, which he enjoys. “It’s sort of the finishing touch or last surgery at the end of the journey. And it’s a very satisfying operation to see the changes that these kids undergo when you do that surgery,” said Prescher.

Aside from cleft care, he’ll be taking trauma call, along with handling cranial vault reconstruction and facial feminization surgeries for transgender patients.

He’s also looking forward to teaching and working with the residents and medical students in the clinic. Prescher’s teaching style? It depends on their experience level, so he tries to give them as much guidance as they need to be confident, competent and willing to push themselves.

“Sometimes they need more help in the beginning and then they’re off and running so you can just stand back and watch. That’s the fun part of teaching.”