Boil pasta: Bring a large pot of well-salted water to a boil. Cook fettuccine until al dente. Scoop out 1 cup pasta water.
Start sauce (low heat): In a wide pan, melt butter. Stir in cream; heat until steaming (do not boil). Add garlic for 30 seconds if using. Turn heat to low.
Emulsify: Off the heat, whisk in Parmesan until smooth. Add ¼–½ cup pasta water to make a silky sauce.
Toss: Add drained pasta to the pan. Toss vigorously 30–60 seconds, adding splashes of pasta water until glossy and well-coated.
Finish: Season with salt and black pepper. Plate hot with extra Parmesan (and parsley if you like). Enjoy!