Ultrasound is sound waves with frequencies higher than we can hear. Ultrasound has been used for decades as a diagnostic tool to create images of structures within our bodies. For aesthetic treatments so-called high-intensity focused ultrasound is used. Ultrasound induces damage to skin cells by heating the deeper layer of the skin (dermis), while leaving the upper skin layer (epidermis) unaffected. The purpose of the damage in deeper skin layers is to create a healing response and skin tightening effect and to reduce the appearance of wrinkles.
Reference:
Park H. et al., High-Intensity Focused Ultrasound for the Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas, Ann Dermatol. 2015 Dec; 27(6): 688–693.