First of all, wow. I can't believe I didn't notice this gem for well over 5 years. Holy crap what a ride, but let's get to it.
Pale Carnations is a game that explores the dens of hedonism and debauchery, a focus around a brothel for rich and corrupt perverted bastards to flaunt their wealth and indulge in their twisted desire to show dominance over women while they socialize with their peers.
You are not one of those twisted bastards, you are Edwin Turner (Name Determinant), a 21 year old Med-Student living in a cheap apartment and struggling to make the funds to get through Med School, before an invite courtesy of your best friend Killian (Ian) Beaufort, and his uncle Charles (Chuck) Kohler, your mentor, winds up at your doorstep.  Within the invitation, lies the premise of joining the previously mentioned brothel, the "Carnation Club", as a staff member that will attend to the needs of the patrons, the working girls at the brothel, and most importantly, working for the Annual Summer event. A Four week-long event where 3 women, or "Carnations", compete for a grand prize that will give them the financial aid and power they need to overcome their very reason for joining the event in the first place. Edwin's role is to personally aid and care for the Carnations so they can survive the month of Hell that awaits them, all for the sake of getting the money he needs to get through his medical school bills.
But as the den of debauchery clouds Edwin's mind, he thinks about his own desires, ones that he's tried to keep hidden from everyone else: the desire to hurt people, to dominate women, to treat them like objects for his outlet of lust.  As the player you basically get to control how much Edwin indulges in these primitive desires that he is afraid of.  Completely resisting them may lead to others walking all over you, though you'll certainly be seen as a kinder person by most, while over-indulgence can lead to others hating you, with some respecting your creative nature in sadism.   Likewise, there are those who are more than okay with the middle-road, where some will enjoy it if you indulge in a bit of sadism without going too far...
So you have to weigh these choices as you engage with the Carnations on their path to winning the weekly exhibitions in order to win the grand prize, and your actions can help them shine brighter and win easier, if you choose.  Will you show more favorability towards Rosalind, the single mother whose deadbeat husband left her with crippling debt and nowhere else to turn to? Will you help Veronica, the silver medal athlete who is at risk of losing her gym and is too prideful to let go of the last bit of her dream from crumbling?  or will you find more rapport with Felicia, the hedonistic trophy wife of an entrepreneur, who is desperately trying to claw out of a gilded cage of her own making?  Will you find more romantic relationships with other women, like your sadistic boss, Kathleen, who sees the monster that Edwin tries to hide inside himself, and wants to bring it out to make him more like her?  Maybe you find your best friend's  cute girlfriend, Mina, too irresistible to leave alone while your best friend is busy flirting with other women in his womanizing ways. Or maybe Hana, the goth bartender at the Carnation Club who is stuck working there for personal financial reasons, and is hoping to find a kindred soul that finds the club as deplorable as she does.
Before this all even starts, however, you have to determine a large part of Edwin's backstory. Yes, a visual novel with a character creator, and permanent traits no less, that based on background choices, you can take special dialogue choices that would otherwise be unavailable. For example with Strongman, Edwin is bulkier, a bit stronger, and able to be more intimidating than normal, and with Social Chameleon he can lie and deflect his way through any conversation.  These all have an impact on the story in whole, as well as valuable choices you can make, so mix, match, and experiment.
The game runs with a bunch of dialogue choices and a lot of flag variables that help determine how the story progresses. Some stuff is quite missable if affection or trust values aren't high enough, or you didn't get a high enough score via dialogue choices in the scene you're in, etc, so you can be certain that the game invites multiple playthroughs and making impactful choices involving the 6 main female leads, as well as side-characters that may help Edwin if they're on good enough terms and you leave a good enough impression.
Sound is very well balanced in this game. There's some silly and dramatic audio cues, and plenty of Royalty Free music you may or may not have heard in other titles you can find on this site.
Most sex scenes are animated as well, with some blending of stills in the mix, and for a Honey Select-based game, the character models and maps are very well designed and placed throughout the game, leaving little room for critique.
The story, if I hadn't laid it on thick enough, is very well written for a game focusing around smut, and a heavy amount of the game's theme focuses around sadism. If you like seeing women get spanked, whipped, and occasionally choked (asphyxiation play in general), this is the game for you.  How far you go as the main character is entirely determined by you, as no one can truly force you to be the monster several characters (and sometimes even your own inner thoughts) want you to be. You can treat some characters like absolute garbage and degrade many women, or you can be their ally and shoulder to lean on. Show dominance or show compassion, or mix both, the choice is up to you.
As of this review the game is not complete yet, but I had a wonderful time playing it, and can't wait for more updates.