If you have an "analog" foundry flow you probably have at
least one thin-film resistor. Fusible links are just a minimum
width resistor with oversized endcaps and interconnect
capable of supporting the fusing current short term. The larger
effort is designing the sense & switch circuitry, and protecting
the things you -don't- want to blow up, from the blow-energy.
Poly is one option, sometimes you also find thin film resistors
up in the interconnect stack. These latter may have better-
controlled value and tempco than poly. However a high-sheet-
resistance film is more difficult to get the blow-power into.
Gate zap is another commonly supported trim scheme.
For a commercial product you would want to be using whatever
the foundry has already qualified, because qualifying it on your
own will be a long, expensive and risky proposition.
You need to consider having two trims, one for tempco and
one for voltage afterward, to make up for the skew of the tempco
trim.
At one pad per bit the size will be dominated by pads; a serial
interface may not be much smaller as a programming switch
per bit would then take the place of pads. At 0.18 you may
come out ahead, at 0.5um I have seen pad-per-bit come out
more efficient.
If your chip already happens to have a serial interface and
register resources then I would spend my effort on an internal-
programming-switch design.
In a junction-isolated technology you may find using a substrate
BJT to deliver the current works out best. I work mainly on
SOI these days, so no such luck.