Boil a big pot of salted water. Cook tortellini according to package directions until al dente. Save a cup of the pasta water in case you need to loosen things up.
While pasta cooks, heat olive oil in a skillet over medium heat. Add minced garlic and sauté for about 30 seconds—don’t burn it or you’ll taste the floor of a garlic cave.
Pour in pesto and cream. Stir to combine until it’s creamy and shiny. If you’re using cream cheese, whisk it in until smooth.
Add Parmesan and a splash of the reserved pasta water to reach your preferred sauce consistency. Season with salt and pepper. Taste and adjust—you’re the boss here.
Drain tortellini and toss it into the sauce. Stir gently to coat every nook and cranny. If it looks a little thick, loosen with more pasta water.
Serve hot, with a sprinkle of extra Parmesan and optional toppings. Enjoy the speed-dating of flavors in your bowl.