Tungsten will be used as the plasma-facing divertor material in the International Thermonuclear Experimental Reactor (ITER) fusion reactor. Under high temperatures and high ion fluxes, a ‘fuzz’ nanostructure forms on the tungsten surface with dramatically different properties and could contaminate the plasma. Although simulations and experimental observations have provided understanding of the initial fuzz formation process, there is debate over whether tungsten or helium migration is rate-limiting during late-stage growth, and the mechanisms by which tungsten and helium migrations occur. Here, the proposed mechanisms are considered in turn. It is concluded that tungsten migration occurs by adatom diffusion along the fuzz surface. Continual helium migration through the porous fuzz to the tungsten bulk is also required for fuzz growth, for continued bubble growth and rupture. Helium likely migrates due to ballistic penetration, although diffusion may contribute. It is difficult to determine the limiting process, which may switch from helium penetration to tungsten adatom diffusion above a threshold flux. Areas for further research to clarify the mechanisms are then considered. A greater understanding of the fuzz formation mechanism is key to the successful design of plasma-facing tungsten components, and may have applications in forming porous tungsten catalysts.