Most people overcomplicate this. A great cream sauce is butter + cream + cheese + salt. The secret is emulsification — pasta water is your best friend for silky texture without greasiness.
Garlic cream: Add 3-4 minced garlic cloves to melted butter, cook 1 minute until fragrant before adding cream.
Tomato cream (vodka sauce): Add 1/2 cup tomato paste to butter, cook 2 minutes, then add cream. Optional: 1/4 cup vodka after tomato paste (cook off alcohol for 2 minutes).
Mushroom cream: Sauté 8 oz sliced mushrooms in butter until golden, then add cream.
Pro tip: For restaurant-level consistency, finish with 1 tbsp cold butter off heat and swirl the pan — this is called monter au beurre and creates that glossy, velvety finish. If sauce gets too thick while sitting, add pasta water 1 tbsp at a time, not more cream (which makes it greasy).
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