Bring a large pot of salted water to a boil and cook the fettuccine until al dente according to package instructions; reserve 1 cup of the pasta cooking water, then drain the pasta and toss with a little olive oil if you are not adding it to the sauce immediately.
While the pasta cooks, melt the butter in a large saucepan over medium heat.
Whisk the milk together with the cornstarch (1 Tbsp + 1 tsp total) until smooth to make a slurry.
Add the minced garlic to the melted butter and sauté about 30 seconds until fragrant, taking care not to brown it.
Stir in the heavy cream, the milk–cornstarch slurry, softened cream cheese (if using), dried basil, dried parsley, onion powder, dried oregano, salt, pepper, red pepper flakes, and nutmeg if using; reduce heat to medium-low and cook, stirring, until everything is melted and smooth.
Add the grated Parmesan in 3–4 handfuls, whisking until smooth between additions, then bring to a gentle simmer and cook 3–5 minutes until the sauce thickens slightly (it will thicken more as it cools and when tossed with pasta).
Add the drained fettuccine to the sauce and toss to coat; if the sauce becomes too thick, loosen it with small splashes of the reserved pasta water until you reach the desired consistency.
Taste and adjust seasoning with additional salt and freshly cracked pepper, then serve immediately and garnish with fresh parsley if desired.