Step 1: upload the "image" to the site. Let the site do whatever it does to ensure it has received a valid image. Nine validators out of ten will happily accept the file; the case that is likeliest to shoot you down is if the site modifies the image by cropping, resizing, or watermarking it.
Step 2: point your victim back to the uploaded "image" as though it's actually a page, and presto!, it's a page -- a page with malicious javascript in it.
Step 3: profit!