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Bring a large pot of salted water to a boil. Add the fettuccine and cook al dente (slightly firm). Reserve ½ cup pasta water. Drain pasta (do not rinse) and set aside.
Meanwhile, in a 10-inch skillet, melt the butter over medium heat. Add the garlic and cook just until fragrant, about 1 minute.
Stir in the heavy cream and bring to a simmer. Let simmer uncovered until slightly thickened, about 5-7 minutes.
Remove the cream mixture from the heat and whisk in parmesan cheese and a pinch of nutmeg until smooth. Season with salt & pepper.
Add the cooked fettuccine to the skillet and toss with the sauce. If needed, add additional pasta water to adjust the consistency.
Garnish with parsley and additional parmesan cheese if desired.