I've got a couple of 2008 R2 server core installs and they have three fewer patches (5 v 8) than a 2008 R2 full install. It's early days for R2 in terms of patches but I imagine the trend will continue. With a far smaller complement of features the core install will need fewer patches (explorer, ie, mmc to name a few).
In WSUS you approve the patches for install but they'll only be installed if required.