Bring a large pot of salted water to a boil. Add the fettuccine and cook according to package instructions until al dente. Drain and set aside.

In a skillet over medium heat, melt the butter. Add the minced garlic and sauté for about 1 minute until fragrant.

Pour in the heavy cream and bring to a gentle simmer. Stir frequently.

Gradually whisk in the grated Parmesan cheese until melted and smooth. Season with salt, black pepper, and nutmeg if using.

Add the cooked fettuccine to the sauce and toss to coat evenly. Serve immediately with extra Parmesan cheese on top.